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Acute and long-term neurodevelopmental outcomes in children following bone marrow transplantation
1Department of Pediatrics, Dept. of Pediatrics (D-820), P.O. Box 016820, Miami, FL 33101, USA. darmstrong@miami.edu
Insights
Bone marrow transplantation (BMT) can cure childhood cancers and metabolic disorders but may pose neuropsychological risks. Understanding pre-BMT factors and developmental models is key to improving neurodevelopmental outcomes for children.
Area of Science:
- Pediatric Hematology/Oncology
- Neuroscience
- Transplantation Medicine
Background:
- Bone marrow transplantation (BMT) is a curative option for various pediatric conditions, including cancers, sickle cell anemia, metabolic disorders, and leukodystrophies.
- The neurodevelopmental impact of BMT in children is complex, with potential for both adverse effects and improved outcomes.
- Several factors influence the neurocognitive trajectory following BMT, necessitating a thorough understanding for optimal patient care.
Purpose of the Study:
- To explore the dual potential of BMT to cause neuropsychological toxicity or enhance neurodevelopment in children.
- To examine critical factors influencing neurocognitive outcomes post-BMT, including pre-BMT therapy, age, total body irradiation, and graft-versus-host disease (GVHD).
- To review a developmental model for understanding BMT-related neurocognitive effects and discuss intervention strategies.
Main Methods:
- Literature review and synthesis of existing research on BMT and neurodevelopmental outcomes in pediatric populations.
- Analysis of factors contributing to neurocognitive toxicity and improvement.
- Examination of a developmental model for neurocognitive effects.
Main Results:
- Pre-BMT treatment, patient age, use of total body irradiation, and GVHD-related toxicities significantly impact neurocognitive outcomes.
- BMT can lead to either increased neuropsychological toxicity or improved long-term neurodevelopmental outlook depending on disease and treatment variables.
- A developmental model provides a framework for understanding the emergence of neurocognitive effects.
Conclusions:
- The neurodevelopmental impact of BMT in children is highly variable and influenced by multiple factors.
- Careful consideration of pre-BMT conditions and treatment modalities is crucial for mitigating risks and optimizing neurocognitive outcomes.
- Further research and targeted interventions are needed to support the long-term neurodevelopmental health of pediatric BMT survivors.
Abstract:
Bone marrow transplantation offers a potential cure for a number of childhood cancers, sickle cell anemia, and stabilization of a deteriorating and debilitating process in a number of metabolic disorders and leukodystrophies. Depending upon the disease, treatment prior to BMT, and natural history of the disease, BMT may increase the risk of neuropsychological toxicity for children undergoing BMT, or may actually improve their long-term neurodevelopmental outlook. The role of factors such as pre-BMT therapy, age at time of treatment, presence or absence of total body irradiation, and toxicities associated with GVHD are presented for consideration. A developmental model for understanding the emergence of neurocognitive effects of BMT is reviewed, and strategies for intervention are considered.